Dangerous diagnosis - placental abruption in late pregnancy

2023 Author: Alfred Shackley | [email protected]. Last modified: 2023-05-21 13:14

The placenta is the organ that circulates oxygen and nutrition from mother to fetus. This "fleshy cake" adjoining the wall of the uterus is often called a baby's seat. The embryo communicates with it through the umbilical cord.

Placental abruption in late pregnancy is one of the most dangerous diseases that cause justified concern in the expectant mother. Doctors recommend going to the hospital at the first symptoms of the problem so as not to endanger the child's life.

The value and function of the placenta

After conception, various changes occur in a woman's body, one of which is the appearance of a new organ - the placenta. It is the connective tissue that is essential for the life of the fetus.

It has important functions:

• gas exchange - the supply of oxygen to the fetus and the removal of carbon dioxide emitted by it;
• maintaining a normal level of hormones in a woman's body;
• protection - the child is protected from contact with infections;
• nutrient - substances necessary for the growth and development of the fetus enter through the placenta.

Placenta separation symptoms

The norm is the separation of the placenta half an hour after the birth of the baby. Premature separation of elastic tissue from the wall of the uterus is called placental abruption. Such a diagnosis in the initial trimester of pregnancy is less dangerous; with timely admission to the hospital, the fetus is saved, prescribing special drug therapy. The tissue itself is in the stage of growth and enlargement, therefore, the pathology is compensated for in a natural way.

During this period, a frivolous attitude towards one's own body threatens the loss of the child, in the later stages, both the baby and his mother are threatened. Doctors have to urgently save their lives by caesarean section.

This pathology occurs in one out of 120 pregnant women, the perinatal mortality rate is 15%. Violations in the functioning of the organ cause bleeding and squeezing of a certain area, which stops the metabolic process between mother and child. The problem has the following symptoms:

1. Discharge from the genitals contains blood or bleeding occurs - the main indicator of placental abruption. It is observed in 80% of patients with this pathology. The intensity of the discharge depends on the degree of tissue detachment. This is the so-called external bleeding, which a woman detects in a timely manner and goes to the hospital. In the remaining 20% of cases, internal bleeding occurs, in which blood accumulates at the site of tissue separation. In such a situation, doctors are faced with the only choice - to save the woman's life by removing the fetus along with the uterus.
2. Drawing pain in the lower abdomen - this symptom invariably accompanies uterine hypertonicity. With internal bleeding, it manifests itself especially intensely. The hematoma, as it grows, pressing on the uterus and abdominal cavity, causes intense pain. Other signs accompanying internal bleeding: nausea, weakness, a state close to fainting.
3. Heart rhythm disturbances, anxiety are indirect signs of placental abruption in late pregnancy.

Fetal activity, which increases with slight hypoxia (lack of oxygen) and decreases markedly with progressive organ separation, can signal a problem. The separation of half of the connective tissue leads to the death of the child.

Placental abruption

Pathological changes in the body associated with the detachment of the child's seat are divided into 3 stages:

• Light form - slight detachment, marginal. There is a small vaginal discharge with blood and an excitability of the uterus. At this stage, the child and mother are not affected. It goes away without consequences, thanks to the formation of blood clots that stop bleeding. It is found during ultrasound or after childbirth.
• Detachment of moderate severity - from the woman's side is accompanied by bleeding, increased heart rate and hypertonicity of the uterus. With detachment from a third to half of the placenta, the child experiences a sharp oxygen deficiency. The functioning of his heart slows down, the fetus is threatened with death from oxygen starvation. Painful sensations of a woman are periodic in nature, are given to the perineum and lumbar region.
• Severe degree - the tissues are exfoliated by more than half, the process is accompanied by acute pain, intense bleeding or its absence. When the central part is separated and the placenta is filled with blood, the woman's abdomen swells, the uterus becomes asymmetric. A noticeable condition characteristic of significant blood loss, pallor of the skin, cold sweat, low blood pressure. The heartbeat stops in the fetus, it dies from lack of oxygen.

Determining the degree of placental separation allows doctors to choose treatment tactics and make a prognosis for the further course of pregnancy. The second and third stages of detachment of the child's place leave no chance to preserve the fetus. The initial and non-progressive degree of separation gives hope for a favorable outcome and requires regular monitoring.

Causes of placental abruption in late pregnancy

It is not for nothing that the placenta is called a child's place; the life of the fetus depends on its functioning. An organ with a complex structure, permeated with blood vessels, is under constant pressure from the ovum and the muscles of the uterus. The balance of the two resultant forces and the high elasticity of the tissue prevent premature separation of the organ.

The main factor provoking placental abruption is not clear. The causes of detachment lie in the woman's health problems and the influence of external factors. Doctors consider the problem to be multifactorial, that is, the pathology is caused by a set of negative circumstances:

1. High blood pressure in a pregnant woman.
2. Frequent childbirth provokes changes in the tissues of the endometrium, as a result of which the baby's seat is poorly retained.
3. Injury to the abdomen during a fall or impact provokes a hematoma.
4. Disorders of the endocrine system of the mother: diabetes mellitus, hyperthyroidism, adrenal diseases.
5. Pressure fluctuations caused by stress.
6. Inflammatory processes of the uterus.
7. Postterm pregnancy, the tissue of the child's place begins to degrade and flake off.
8. The occurrence of inflammatory processes in the uterus or placenta due to infectious and other diseases.
9. Low localization of the child's place, subject to excessive pressure from the child.
10. Allergic reaction to drugs.
11. Smoking and drinking during pregnancy.

Placental abruption in the last trimester most often requires immediate delivery. Partial separation sometimes allows pregnancy to be carried out in a hospital setting. A timely visit to the hospital when symptoms of detachment of the child's seat appear will help prevent dangerous consequences.

Diagnosis of pathology

The clinical nature of the disease does not pose any difficulties in making a diagnosis. The doctor examines the anamnesis, listens to the patient's complaints.

• The main way to diagnose organ separation is to perform an ultrasound of the placenta. This procedure provides information about the location, size and nature of the exfoliation. Mild pathology is determined by the presence of blood clots. The gynecologist examines the patient, finds out the condition of the cervix.
• Additionally, the pregnant woman is tested for blood clotting and CT scan (cardiography) to study the fetal heartbeat. Signs of bleeding disorders are considered extremely dangerous. The results of both ultrasound and CT scan reveal signs of hypoxia in a child. Based on the research data, the doctor makes a recommendation for the further course of pregnancy.
• If the due date is close, then doctors insist on speeding up the process - carrying out a cesarean section. If the term is insufficient, assessment takes place, which poses a great danger to the child - premature birth or progressive detachment.

Treatment

Treatment tactics depend on the situation. At a period of 34-36 weeks, with a slight vaginal bleeding, a woman's pregnancy is prolonged in a hospital. The patient is assigned to take antispasmodics:

1. Baralgin;
2. Papaverine;
3. No-shpa.

The following drugs are prescribed to stop bleeding:

• Vikasol;
• Decinon.

To exclude anemia, therapy is carried out with the appointment of ascorbic acid and iron preparations:

1. Tardiferon;
2. Ferroplex;
3. Sorbifer.

The patient must adhere to bed rest.

In the case when the birth canal is prepared, doctors resort to opening the fetal bladder and natural childbirth is carried out. Reducing the pressure of amniotic fluid prevents placental abruption during labor. It takes place under cardiac monitoring, which controls the fetal heart rate and uterine tone. If the child's condition worsens or a woman develops intense bleeding, doctors perform surgery (caesarean section).

In parallel with delivery, the patient is supported by the introduction of donor blood, anesthetics, and infusion of solutions. After delivery, the placenta is removed manually and the uterus is examined. In a situation where there is no way to stop the bleeding, the organ is removed completely.

Prophylaxis

Despite the fact that it is impossible to indicate unequivocally the reason why placental abruption occurs, there are several preventive recommendations:

• The expectant mother should take care of her health and the life of the baby on her own, giving up bad habits: smoking, drugs, alcohol.
• A woman should receive adequate nutrition, with a sufficient amount of iron, vitamins and minerals.
• Before conception, it is necessary to cure existing diseases.
• During pregnancy, it is recommended to regularly visit a gynecologist, timely take tests and follow the doctor's prescriptions.